Each year in the United States, millions of people submit themselves to abdominal surgery for a variety of reasons, including gynecological reconstruction, tumor removal, and Cesarean sections. While the success rate and recovery times for the initial surgeries are continually improving, complications still frequently occur. One major complication of abdominal surgery, occurring in 65-97% of patients, is the formation of post-surgical adhesions [5,6]. Post-surgical adhesions are comprised of acellular, collagen-rich tissue and often form when an organ or tissue is damaged due to inadvertent desiccation or trauma during retraction [17]. During healing, this damaged tissue often becomes attached to adjacent tissues by the formation of a fibrous scar that connects adjacent tissues, resulting in the formation of a post-surgical adhesion.
While these adhesions are generally not problematic and in many cases are asymptomatic, in some cases, these adhesions can lead to serious problems including abdominal or pelvic pain, intestinal obstructions (e.g., bowel obstructions), infertility, or increased difficulty in subsequent surgical procedures that require physician care [5,17,32]. In addition to the immeasurable costs in patient pain and suffering, in the United States alone, an estimated 440,000 adhesiolysis procedures are performed annually to correct issues arising from the formation of adhesions, resulting in annual financial expenditures estimated to exceed $1 billion [7,8].
Numerous attempts have been made to develop approaches to prevent adhesion formation, with the approaches generally being divided into three main categories: modification of surgical procedures [32], biological approaches, and barrier methods [82]. To date, however, no method has been developed that can prevent the formation of adhesions in most or substantially all cases. While improvements in surgical techniques have reduced instances of post-surgical adhesions for some procedures, the most successful methods to prevent adhesions to date have relied on physical barriers to separate damaged tissue surfaces [7,32]. Progress in patient outcomes has been made by using these physical, adhesion barriers, but current barrier methods are still limited by the fact that the barriers must be applied directly to the area of damage. This direct application of the barriers often precludes their application in laparoscopic surgeries and, in many cases, the barriers are unable to prevent certain post-surgical adhesions, as the damaged tissue cannot necessarily be identified or accessed by the surgeon. As such, if damaged tissue is either unknown, inaccessible, or difficult to fully access, current barrier methods will not be effective and adhesion formation remains a likely outcome. To overcome these deficiencies and to prevent the occurrence of post-surgical adhesions, the ability to further protect damaged tissue, including unknown and inaccessible damaged tissue, is thus desired.